GAO Tells CMS to Require Broader Hospice Reporting

WASHINGTON, DC—The Centers for Medicare & Medicaid Services (CMS) should require hospice care providers to report all allegations of abuse and neglect immediately to survey agencies, regardless of whether the alleged perpetrator is affiliated with the hospice, the Government Accountability Office (GAO) urged in a new report.

The Department of Health and Human Services neither agreed nor disagreed with GAO’s recommendation.

The National Association for Homecare and Hospice (NAHC) applauded the GAO for identifying the gaps that could “delay reporting of potential abuse.”

“GAO’s common-sense recommendation that hospice requirements be brought in sync with the requirements applicable to nursing homes and hospitals providing extended care is one that should be implemented with all due speed,” said Theresa Forster, NAHC’s vice president for hospice policy.

“Further,  NAHC  strongly urge s  that, in tandem with the GAO’s recommendation, the Department of Health and Human Services take action to implement  proposals put forth by the Office of the Inspector General during 2019 recommending that hospices be required to develop written policies and procedures for investigating and reporting suspicions of abuse, neglect, and other harm, and supply hospices with informational materials to assist them in educating their staff in recognizing signs of abuse, neglect, and other harm to patients under their care,” Forster continued in a prepared statement. “Utilization of the hospice benefit has grown significantly in recent years in response to the recognition that it provides a caring and compassionate approach to end-of-life care. NAHC will continue to work with policymakers to strengthen the program’s ability to protect vulnerable patients from harm.”

In its report, “Abuse and Neglect: CMS Should Strengthen Reporting Requirements to Better Protect Individuals Receiving Hospice Care,” The GAO found that “hospice care providers’ reporting may be less complete or timely than that of nursing homes and hospitals providing extended care.” That’s because hospices (both in homes and in other settings) are only required by CMS to report allegations to state agencies responsible for monitoring them if:  

• the alleged perpetrator is affiliated with the hospice; and
• after the hospice has verified it as abuse or neglect based on an internal investigation that could take up to 5 days.

Nursing homes and hospitals providing extended care, on the other hand, are required to report all abuse and neglect allegations, regardless of whether the alleged perpetrator is affiliated with the hospice and prior to conducting an internal investigation. That means, for example, that hospices are not required to report allegations of abuse by an individual’s caregivers, such as family members.

“Immediately reporting all allegations to survey agencies before providers conduct investigations is important because the agencies use abuse and neglect allegations to inform decisions about the need to conduct their own unannounced on-site investigations of hospice providers,” the report says. “These investigations can ensure, for example, that the hospice has worked within the scope of its authority to protect individuals receiving care. Strengthening hospice reporting requirements to align with the requirements for nursing homes and hospitals providing extended care will provide CMS with the information necessary to ensure that hospice care providers are taking appropriate steps within the scope of their authority to protect vulnerable individuals.”

The entire report is available for download here.